Patient: English Cocker
Spaniel, Male, Neutered, 5 years. Gentle dog. No Cocker Rage.
Complaint: Head shaking for several weeks. Dark red ear wax in horizontal
canal. Groomer could not resolve this problem.
Solution: I advised surgery to open up the vertical ear canal so that the
trapped water and debris inside the canals can flow out easily in the long
term. The couple in their 40s knew what I was talking about and agreed to
the surgery.
ANAESTHESIA
Jun 21, 2010. Anaesthesia and Surgery took over one hour.
Pre-anaesthetic dose Domitor 0.25 ml IV. Waited 5 minutes. Isoflurane gas.
Intubate. "How about Zoletil IV?" my assistant Mr Saw asked as in the
recent debarking case, I had used both.
"It is best not to give more sedation drugs than necessary. I will be
using isoflurane which is safest," I advised him. "Less sedation drugs,
less likely to get anaesthetic deaths. If I use Zoletil, I will need to
use Atropine to prevent salivation and muscle tremors. Then I need to top
up as this surgery is going to be longer than debarking as I have two ear
surgeries to do. That means I still need isoflurane gas to maintain
surgical anaesthesia."
Pre-anaesthetic sedation using one drug and isoflurane gas is the safest
method of anaesthesia for dogs and I use this method frequently. In
debarking, I had no choice but to use injectable anaesthetics and there
was the hassle of topping up via the IV catheter. For gas anaesthesia,
just increase the dosage and that is so convenient when the dog is
intubated and given gas. For injectable anaesthetic top up, it is given by
small doses via the saline drip. It is quite convenient too but nothing is
as safe as the isoflurane gas.
"Any surgery consent forms to sign?" the owner had asked me earlier. "The
owner can sign forms for the vet. The important thing is that the dog does
not die on the operating table." Usually I assess the dog's health and the
owner's personality and I seldom give them forms to sign. But I have
always communicated to them the risks of anaesthetic deaths. Consent forms
are common even in human anaesthesia and surgery at the Singapore
hospitals.
Performance (a live dog at the end of surgery) counts a lot. I cannot be
complacent as one anaesthetic death creates massive waves of emotional
upheavals in the owners and the family. This English Cocker Spaniel is
healthy but still no vet can guarantee the owner that the dog will not die
on the operating table.
SURGICAL PROCEDURE
1. Clipped skin of ear to the base, not just partly. My assistant had to
shave more, increasing the anaesthetic time. Put artery forceps to base of
vertical canal to identify the location.
2. Draw the outline of the surgical area from base of vertical canal and
add 50% more length (see picture).
3. Electro-incision of rectangular outline.
4. Excise subcutaneous fat to see the vertical canal.
5. Be careful of a big vein posterior to the vertical canal. If cut,
ligate this vein. Elevate cut skin upwards to see the subcutaneous fat.
Also be careful not to excise the branch of a facial nerve and salivary
glands on the ventral aspect of the incised area. If the facial nerve is
excised, the eye-lids will droop. However, the vet can't see this nerve
easily. Know your veterinary anatomy.
6. Angle forceps at 30 degrees downwards and outwards so that the drainage
board is wide and clamp anterior and posterior edges of vertical canal.
7. Electro-incision on clamped groove.
8. Scissors to cut.
9. Lower the cartilage. Cut cartilage long enough to anchor it to base of
skin. I stitched at the horizontal canal level first. 2/0 absorbable
sutures were used.
10. To illustrate the surgical procedures, some pictures are presented
below. More pictures of the surgical procedures in other dogs are at:
Other case studies
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